Monday, January 19, 2015

Meet My Patients

I would like you to meet the people who keep me so very busy.

This is Salestine.  She had an epulis tumor which is a tumor of the gums.  The tumor had grown so large, she was unable to put food into her mouth.

She was quite malnourished.  She very likely would have died within the year without this surgery.   While Salestine was in the OR for almost two hours, the surgery, from first incision to last suture took only 18 minutes.  The rest of the OR time was spent intubating her for general anesthesia.   It was a very difficult task, putting in a breathing tube.  Here she is post-op, eating one of her first solid food meals in a very long time.
 And here she is at her outpatients visit, about a week after surgery, looking so healthy and happy.

























This next patient has been with us since around December 12th.  A noma had completely destroyed his nose and upper lip.  A noma is a type of gangrene or tissue death that generally effects the mucus membranes of the nose and mouth.
During his first surgery, his scalp was cut from his skull and brought forward.  A portion of the scalp was used to create a new nose.  The scalp was used because of its terrific blood flow.  A skin graft taken from his thigh or groin was placed on the scalp to replace the skin used for the nose.  A tracheotomy tube was inserted so that he could breath.  A feeding tube was also inserted into his esophagus.
In his second surgery the scalp was pulled back to its original position.  The skin graft, as seen here, is located on his left side.  The edges are still healing.  He will have a third surgery to reconstruct his lips.  Right now, his still has his tracheotomy and feeding tubes, as seen in his neck.

The doctor literally created an entire nose for Mamisy.  It is amazing.  Although the ship brings many first world, medical advantages to Africa, we do not always have the exact implants necessary for every possible surgery.  What the doctors do with the resources we have is simply miraculous.

This little girl is Hermina.  She had a teratoma removed from her bottom.  She has been with us since late November.  The surgical wound was quite significant - both long and deep.  About one week after her surgery, she fell down while walking and opened her incision.  She is just under two years old, and, as an active toddler, she took off when her mother turned aside for just a moment.  Hermina fell down when her little legs could not quite keep up with the rest of her.  She was rushed into surgery to repair the damage.  Afterward, her mother held so firmly to her arm or gown wherever she went.  The doctors have kept her at the hospital to ensure that the wound heals well and without infection.  She was transferred last week to the Hope Center.  This is good news and indicates she is healing well.

However, having been here for so long, she made friends with other children.  It was sad to see her leave.

























This young man's name is Venance.  A noma destroyed his lower lip.  The doctors removed the infected tissue during the first surgery.  In his next surgery, the doctors will reconstruct the lower lip.























This little one is Jida.  She came from the capital with her uncle.  She stayed with us for over a week before her surgery.  She was shy and distrustful of us at first.  After one week of friendly overtures, we finally won her over.  This is Jida before her surgery.

And here she is after, gazing at her new face.
And cuddling with her stuffed bear.

This next little girl is Mitia.  She also traveled quite far to reach us.  She was a very happy 6 month old. She was also quite chubby, thanks to a diet of sweetened condensed milk.  The nutritionist worked with the mom to ensure Mitia will get a better diet post surgery.


This young man is Thomas.  He had his cleft palate repaired.  Another organization repaired his cleft lip many years ago.


He really enjoyed playing with the Jenga blocks, though he did not play with them in the usual manner.

This last week, I cared for Ezra, a rambunctious 7 year old boy who was born with a foot deformity.  The surgeons repaired the foot so that he could walk normally.

In the bed next to him was a 17 year old young man, Largisse.  The surgeon released a burn contracture of his right elbow and placed a skin graft over the site from his thigh to increase function and appearance.  He is a typical teenager, always trying to bend the rules.  God has surely used Largisse to increase my patience.
And, finally, on the containers, the new special nipples for cleft palates arrived!  Here is one infant that benefitted from the new arrivals.  Although she was never my patient, I met her and her mom during a meeting with the nutritionist.  At ten months old, this infant was less than 5 kilograms (11 pounds).  She joined the Infant Feeding Program.  We provided formula and rice cereal.  The baby came to the ship several times a week for weight checks and to receive new supplies.  The baby continued to lose weight over the next month.  So, our nutritionist admitted the baby to the hospital.  With the nurses overseeing the feedings, the baby gained weight.  About a week before her discharge, the new nipples arrived.  It made the feedings much easier, both for us and the baby.  The doctors have scheduled the cleft lip repair for the end of the month.  Praise God!  Her cleft palate repair cannot be repaired until she is older.

























I have enjoyed my work over the last month.  Nursing is much different here.  Sure, I still perform nursing tasks.  But I also play with the patients.  My particular favorite is a Sponge Bob memory game, though I also enjoy Dominoes - the games can get quite intense.

I hope you enjoyed meeting my patients!

However, it has not all been fun and games.  This little girl, Genesca, came to us hoping we could help her.  We performed a CAT scan and biopsy.  The results were not good.  The tumor is cancerous.  When she returned to the ship for her results, she was quite ill.  She had an infection.  We tended her through the infection but were unable to help her further.  We are not able to care for cancer patients.  We do not have chemotherapy nor radiation therapies.  The surgery would not prolong her life but would make her susceptible to infection.  With very heavy hearts, we told her family the news.  She is now back at home, though once again quite ill.  Her family is with her, loving and supporting her.  Please pray for her and her family.


























Monday, January 5, 2015

Belated Wishes

Joe and I want to wish you all...

Merry Christmas…belatedly...

and a Happy New Year…also belatedly.

Christmas was both wonderful and difficult.  Difficult for the obvious reasons - missing people and traditions.  Wonderful because we felt very loved.

There were many events held over the last month.  Here is Christmas by Candlelight:
Even our patient's joined in the fun…
 We did receive a few gifts from our friends onboard.  (Notice the mac & cheese…a friend remembered that it is my comfort food.)

On Christmas Day evening, we opened our door for "Open Cabins."  Couples and families opened their doors for more than two hours for anyone wanting to visit.  The event is meant to encourage a more familial feeling of Christmas.  Here I am, with a bowl of homemade ice cream from a neighbor:




























I was worried that Christmas would be awful.  I did not feel at all festive, not even on Christmas Eve.  I spent over six overs baking on Christmas Eve evening.  However, when I awoke on Christmas Day, I found presents and goodies outside my door.  Nothing lavish, but the gifts were thoughtful.  Of course, this was followed by amazing food and fellowship.  It was a good day.  God truly blessed us this Christmas.

A total non-sequitur: I would like to make a request for prayer.  My migraines have been increasing in frequency, duration, and intensity over the last three months.  I have had five in less than four weeks.  I do not wish to go back on a preventative medication for a number of reasons, though I am not even certain if that could be easily done from here.  I have an appointment with our crew physician on Friday.  Please pray that the migraines diminish and that the physician and I are able to find a helpful treatment plan.

Thanks!  I love you!